Blunt trauma to a reconstructed breast

Case contributed by Dr Giorgio M Baratelli

Presentation

Fell forward and hit her chest. Underwent breast reconstruction 9 years earlier after skin-sparing mastectomy for DCIS.

Patient Data

Age: 85 years
Gender: Female
Ultrasound

Left Breast

Ultrasound study of a periprosthetic fluid collection (seroma) without the rupture of the saline implant

Annotated image

a - the skin and the fibrous capsule

b - the periprosthetic fluid collection

c - the silicone shell of the implants

d - the saline fluid of the implant

Case Discussion

The patient had undergone breast reconstruction with expander and saline implant after skin-sparing mastectomy for multicentric DCIS 9 years earlier.

After 9 years, a blunt chest trauma produced a periprosthetic fluid collection (seroma) detected by ultrasound but did not result in a rupture of the saline implant, which would have caused a change in the size and shape of the affected breast.

An ultrasound-guided fluid aspiration and cytological evaluation, required to rule out breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an extremely rare form of lymphoma, were indicated but refused by the patient.

The history of chest trauma, the extreme rarity of BIA-ALCL and the collection of fluid without solid nodules to suggest BIA-ALCL, were considered sufficient for the diagnosis. This was confirmed by the stability of the seroma after 4 years.

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